Division of Neonatology, Children's Mercy Kansas City, Kansas City, MO, USA.
Health Services and Outcome Research, Children's Mercy Kansas City, Kansas City, MO, USA.
J Perinatol. 2021 Aug;41(8):1963-1971. doi: 10.1038/s41372-021-00974-2. Epub 2021 Apr 1.
To determine if multidisciplinary team-based care of severe BPD/CLD infants improve survival to discharge.
DESIGN/METHODS: Retrospective review of severe BPD/CLD infants cared for by dedicated multidisciplinary CLD team using consensus-driven protocols and guidelines.
Total of 267 patients. Median gestational age was 26 weeks (IQR 24, 32); median birth-weight was 0.85 (IQR 0.64, 1.5). Twenty-four percent were preterm with severe BPD, 46% had other primary respiratory diseases (none BPD diseases). Total number of patients, proportion of patients with tracheostomy, prematurity, and genetic diagnoses increased over time. 88.8% survived to discharge. Unadjusted logistic regression showed that tracheostomy was not associated with odds of death; secondary pulmonary hypertension was associated with odds of tracheostomy (OR = 1.795 p value = 0.0264), or death (OR = 8.587 p value = <0.0001), or tracheostomy + death (OR = 13.58 p value = 0.0007).
Over time, mortality improved for infants with tracheostomy cared for by a multidisciplinary severe BPD/CLD team. Secondary pulmonary hypertension was associated with tracheostomy, or death, or tracheostomy + death.
确定多学科团队为严重 BPD/CLD 婴儿提供的治疗是否能提高存活率。
方法/设计：回顾性分析由专门的多学科 CLD 团队使用共识驱动的方案和指南治疗的严重 BPD/CLD 婴儿。
共 267 例患者。中位胎龄为 26 周（IQR 24，32）；中位出生体重为 0.85（IQR 0.64，1.5）。24%为患有严重 BPD 的早产儿，46%患有其他原发性呼吸系统疾病（无 BPD 疾病）。患者总数、气管切开术患者比例、早产儿和遗传诊断的比例随时间增加。88.8%存活至出院。未调整的逻辑回归显示，气管切开术与死亡几率无关；继发性肺动脉高压与气管切开术（OR=1.795，p 值=0.0264）或死亡（OR=8.587，p 值<0.0001）或气管切开术+死亡（OR=13.58，p 值=0.0007）的几率相关。
随着时间的推移，接受多学科严重 BPD/CLD 团队治疗的气管切开术婴儿的死亡率有所改善。继发性肺动脉高压与气管切开术、死亡或气管切开术+死亡相关。
